Provider Demographics
NPI:1164868279
Name:ABUNDANT LIVING CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ABUNDANT LIVING CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY-ANN
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-223-3340
Mailing Address - Street 1:15910 ORANGE BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3402
Mailing Address - Country:US
Mailing Address - Phone:561-223-3340
Mailing Address - Fax:561-223-3249
Practice Address - Street 1:15910 ORANGE BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3402
Practice Address - Country:US
Practice Address - Phone:561-223-3340
Practice Address - Fax:561-223-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty